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NEP 2380 - diet therapy > unit 3 > Flashcards

unit 3 Flashcards

1
Q

What steps can be taken to achieve a healthy start before pregnancy

A

healthy weight, adequate diet, being active, check-ups, managing chronic illnesses, avoiding harmful substances

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2
Q

what is a critical period of development in pregnancy

A

intense stage of rapid cell division

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3
Q

What are two spinal tube defects

A

Spina Bifida, anencephaly

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4
Q

what is spina bifida

A

the tube is not completely closes

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5
Q

what is anencephaly

A

the brain isn’t dvlpted

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6
Q

what are some risk factors in neural tube defects

A

family history, maternal diabetes, folate deficiency, maternal obesity, medicine

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7
Q

what can alter gene expression and lead to chronic diseases in adulthood

A

fetal programming

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8
Q

fetal and maternal health depends on this

A

weight gain during pregnancy

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9
Q

weight gain during pregnancy is correlated with what

A

birth weight and is a predictor of health

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10
Q

weight gain during pregnancy depends on what 2 things

A

number of fetuses, and pre-pregnancy weight

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11
Q

Normal weight gain is how many lbs

A

25-35 lbs

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12
Q

is there an increased energy need in the first trimester

A

There is no increased need but there is a weight gain of 3-5 lbs

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13
Q

increased energy need in the second trimester

A

340 kcals with a gain of 1lbs a week

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14
Q

increased need in the third trimester

A

450 kcals and a gain of 1lbs a week

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15
Q

CHO importance in pregnancy

A

increased need for fetus brain fuel

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16
Q

PRO importance in pregnancy

A

increased need by 25 g a day

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17
Q

FAT importance in pregnancy

A

increased need for EFA for brain development

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18
Q

importance of iron in pregnancy

A

baby is taking moms store of iron so there is

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19
Q

High-risk pregnancy factors

A

low birth weight, gestational age, maternal concerns, glucose mishandling, hypertensive d/o, preeclampsia, eclampsia

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20
Q

what is considered a low birth rate and what is this related to

A

5.5 lbs or less and there is a relationship with SES

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21
Q

gestational age risk to pregnancy

A

baby can be born preterm and if the baby is small they can make up the weight

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22
Q

maternal concerns in risk factors fro pregnancy

A

malnutrition in early and late pregnancy

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23
Q

effects of malnutrition in early pregnancy

A

placenta defects or lack of growth/nutrients

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24
Q

effects of malnutrition in late pregnancy

A

effects of fetal dvlpt

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25
Q

glucose mishandling factors and risk

A

worried about pre-existing diabetes, gestational diabetes

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26
Q

what is gestational diabetes

A

diabetes dvlpt during pregnancy - includes macrosomia

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27
Q

what is macrosomia in gestation diabetes

A

The baby is taking all glucose and the baby weight is increases

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28
Q

hypertensive disorder in pregnancy

A

increases blood pressure and puts mom and fetus at risk

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29
Q

gestations hypertensive disorder

A

high blood pressure dvlp during pregnancy in 2 trimesters and will go back to normal after birth

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30
Q

what is preeclampsia

A

high BP, as well as protein in urine,

can lead to decreased fetal growth and miscarriage

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31
Q

what is eclampsia

A

sudden seizure/ coma

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32
Q

what factors are affected in maternal age

A

there is a risk if mom is 35 or older,

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33
Q

what are three factors in infancy growth

A

weight, length, growth (length-weight, head circumference)

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34
Q

what is the energy need of an infant compared to an adult

A

2x the adult need

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35
Q

where do most nutrients come from birth - 6 month

A

breast milk

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36
Q

where do most nutrients come from while 6-12 mon

A

breastmilk and complementary foods

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37
Q

affects of CHO in infants

A

relative to brain size and is about 12% body weight

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38
Q

affects of PRO in infants

A

limited due to immature kidneys and liver

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39
Q

affects of vitmains and minerals in infancy

A

twice the adult need – vit k supplement shots and vit D for breast fed infants

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40
Q

h20 needs in infants

A

most water is extracellular so there is higher dehydration risk- needs are met by breast milk

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41
Q

what is the majority of nutrients in breast milk q

A

majority fat then carbs, the smallest amount is protein

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42
Q

what are some advantages to breast milk

A

immunological protection, sterile at room temp for 6-8 hours, and colostrum, bifidus factor, decreases allergies, lower cost, weight loss in mom

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43
Q

what is the Bifidus factor

A

increase growth of lactobacillus –

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44
Q

importance of lactobacililus

A

jumpstarts microbiome

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45
Q

what is a con of iron-fortified formula milk

A

no protective ability- lacks immune benefits and antibodies from breastmilk
need safe water and ensure mixed fully,

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46
Q

how often do infants eat breast milk

A

every 2/3 hours and increased time between

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47
Q

how to prevent nursing bottle decay

A

never put baby to bed with a bottle

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48
Q

what is nursing bottle decay

A

tooth decay by cho in the mouth when dipping milk - acid secreted to damage teeth

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49
Q

when is a child allowed to eat solids

A

after 6 months or ready

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50
Q

readiness to eat solid

A

able to hold up the head, and swallow reflex defined

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51
Q

purpose of solids in eating

A

provide nutrients not adequately provided in breast milk

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52
Q

how to introduce new foods

A

one at a time, every 3/5 days before new food to check allergies.

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53
Q

etiquette for childhood eating

A

1+ year eating at the table, drinking from a cup, more adult foods.

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54
Q

in childhood what changes

A

body comp and shape changes increase muscle growth

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55
Q

what happens in children’s appetite at 1 year

A

appetite decreases after 1 yeat

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56
Q

effects of sugar on behavior

A

doesnt cause hyperactivity-caused more by events surrounding intake

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57
Q

ADHD and additives and behavior

A

not universal but some coloring and preservatives

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58
Q

Fe deficiency can affect…

A

attention span, and intellectual performance

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59
Q

effects of skipping breakfast

A

leads to decreased attention span, apathy, shorter attention school,

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60
Q

childhood obesity is

A

on the rise- 1/4 of kids

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61
Q

obesity is based on BMI in the what percentile

A

95-97

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62
Q

what are the consequences of obesity

A

impact on growth, physical health ( CDC risk, HTN, type 2 diabetes), physiological health, leads to adult obesity

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63
Q

nutrient concerns with older adults

A

physiological age ( activity and health) vs chronological age

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64
Q

body weight in older adults,

A

moderate weight not associated with health risks,

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65
Q

body comp changes in older adults

A

decrease in LBM, sarcopenia (decrease muscle mass, adn strength), osteoporosis, risk of obesity,

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66
Q

prevention of obesity

A

physical activity, adequate nutriton esp protein

67
Q

nutritional concerns in older adults,

A

decrease the immune system, inflammation, deficiencies, decrease gi function, dysphagia, tooth loss,

68
Q

energy needs in older adults

A

decrease in energy need, – the importance of energy-dense food,

69
Q

protein use in older adults

A

fighting infection

70
Q

Cho use in older adults

A

fiber

71
Q

water in older adults

A

thirst response, dehydration in UTI, pneumonia, confusion

72
Q

b12 in older adults

A

atrophic gastritis - can have intramuscular injections

73
Q

folate in older adults

A

interferes with folate metabolism

74
Q

vit D in older adults

A

supplements necessary because skin loses abilty to synthesize, and kidney loses abilty to activate

75
Q

Ca in older adults

A

suboptimal in dairy intake

76
Q

what is malnutrition

A

any condition caused by excess or decency of food energy or other nutrients by an imbalance of nutrients

77
Q

causes of malnutrition

A

decreased dietary intake, increased requirements, impaired absorption, altered nutrient intuition

78
Q

history involved in screening and assessment

A

med history, meds and supplements, personal/socail history, food

79
Q

4 types of intake data

A

24 hour recall, food frequancy, food record, observation

80
Q

anthropometric data

A

height, weight, head-circumference (babies), muscle/fat amounts

81
Q

biochemical data

A

urine blood test

82
Q

using weight involves

A

current weight, usual weight, BMI, ideal weight, percent weight loss, fluid retention

83
Q

%usual body weight

A

usual BW/ ideal BW x100

84
Q

%ideal body weight

A

amt weight loss/ usual weight x100

85
Q

who is at risk for malnutrition

A

if weight loss is 10% in 6 mont involuntarily, BMI less than 18.5 or greater than 25

86
Q

effects of protein malnutritions

A

high risk or ulcers, decreases wound healing, higher infection are, extended hospital stay

87
Q

what is etiology based malnutrition

A

seeing where malnutrition is coming from

88
Q

identification of malnutrition

A

use of docs, nurses, dietitians, asses within 24 hours of hospitalization

89
Q

what standardizations are in place when identifying malnutrition

A

AND/ASPEN - clinical char that the dietician can obtain and document to support a diagnosis of malnutrition

90
Q

what are some clinical characteristics

A

insufficient energy intake, weight loss, loss of body fat and muscle mass. fluid accumulation, reduced grip strength.

91
Q

why would you modify a diet

A

for consistency, transition for other parenteral nutrition, before or after procedures, nutrient modification

92
Q

what are some liquid diet options

A

water, coffee, tea,( nothing added) fat-free broth, popsicles, gelatin, sports drinks, no pulp lemonade,

93
Q

what are some texture modifications

A

Pureed ed food - completly smooth. (c)
mechanical soft - mashed ground, minced (b)
soft- moist soft texture (a)

94
Q

what are some strategies for meeting nutrition needs

A

liquid energy supplements, drinking calories, milkshakes,

instant breakfast smoothies, protein bar, boost, ensure

95
Q

Enteral nutrition

A

aka tube feeding- used the GI and gut

96
Q

Cons to enteral nutrition

A

expensive, stressful, complicated

97
Q

How are enteral tubes inserted

A

gastronomy, jejunostomy, nasogastric (short term), stoma opening

98
Q

cons to a tube feeding tube

A

GI bleeding, high output fistulas, uncontrollable vomiting

or diarrhea, intestinal obstruction, severe malabsorption,

99
Q

who can have tube feeding

A

indi with swallowing d/o, upper GI motility issues
GI obstruction, ventilator, higher nutrient requirements,
poor appetite, altered mental status

100
Q

what is reliant on formula selection

A 
nutrient/ energy levels, fluid requirement, osmolarity, fiber need, 
individual tolerance (allergies, sensative)
101
Q

what are the 4 types of formula

A

standard, elemental, specialized formula, modular

102
Q

what is a standard formula

A

commercial blenderized formula

103
Q

what is an elemental formula

A

CHO and PRO are partially or fully hydrolyzed

104
Q

what is a specialized formula

A

specific formula and is specific for diseases

105
Q

what is a modular formula

A

contains a single macronutrient

106
Q

Bolus feeding

A

large volume by syringe every 3-4 hrs

only into stomach

107
Q

intermediate feeding

A

infused over 30-45 minutes, requires more equipment, and is tolerated into the stomach

108
Q

Continuous feeding

A

slow and consistency (8-24hrs). tolerated into the stomach and small intestine

109
Q

Transition to oral intake

A

gradually off tube while oral intake increases must come 2/3 nutrients by mouth, may continue at home,

110
Q

parenteral nutrition

A

based on appetite, GI function, and length of need

111
Q

who can have parenteral nutrition

A

severe GI bleeding, high fistula output, uncontrollable vomiting and diarrhea, intestinal block, severe malabsorption, paralytic ileus

112
Q

When is Parenteral nutrition not used

A

if the patient is well nourished and not able to eat for 7 days

113
Q

PPN

A

peripheral parenteral nutrition - used peripheral veins,

114
Q

TPN

A

total parenteral nutrition - catheter inserted and close to the heart

115
Q

characteristics of PPN

A

short term less than 2 weeks, limited nutrient supply due to blood flow dilution

116
Q

characteristics of TPN

A

central veins, long term, grtr nutrient concentration, best for those with fluid restrictions,

117
Q

PRO Parenteral solution

A

amino acids

118
Q

CHO in the parenteral solution

A

glucose into dextrose supplies energy and complete breakdown,

119
Q

Lipid emulsions in parenteral solutions

A

supplies EFA plus energy, need an emulsifier to keep in suspension

120
Q

fluid and electrolytes in parenteral solutions

A

adjust to the patient need for fluid, electrolytes, acid/base balance,

121
Q

how long are you on parenteral nutrition

A

can be continued for critically ill, cyclic infusion for longterm and gives more freedom for 8-14 hrs infusion

122
Q

steps to discontinue parenteral nutrition

A

adequate GI function, minimal aspiration risk, lower appetite issues, 2/3 nutrients met by other means,

123
Q

complication wit TPN

A

hyperglycemia, hypoglycemia, hypotriglyceridemia, Refeeding syndrome, lie disease, gallbladder disease, metabolic bones disease, infection

124
Q

what is refeeding syndrome

A

the result from hormonal and metabolic changes associated with starvation should start feeding slowing

125
Q

what happens in refeeding syndrome when food is first given

A

increase in…blood glucose, insulin, and anabolic occurrence- creates an electrolyte imbalance

126
Q

what are some disorders of the upper GI

A

dry mouth, mouth ulcers, difficulty chewing, dysphagia

127
Q

treatments to dry mouth

A

salvia substitutes

128
Q

dietary help to dry mouth

A

lemon drops, sugarless gum, moist, soft foods, drinking water, need proper oral hygiene.

129
Q

what are mouth ulcers

A

lesions or sores inlining of mouth,

130
Q

dietary interventions to mouth ulcers

A

decreased spicy, salty, and acidic foods, softer texture, cold food, and drinks.

131
Q

reasons for chewing difficulty

A

problems with teeth or lack of them, mouth surgery

132
Q

dietary intervention to chewing difficulty

A

consistences change in food texture

133
Q

dysphagia

A

difficulty swallowing

134
Q

oropharyngeal phase

A

involves mouth and pharynx - - inability to get food to the back of the throat into the esophagus

135
Q

reasons for oropharyngeal phase s

A

Alzheimer’s, Lou Gerig’s disease, MS, Parkinson’s disease, stroke

136
Q

esophageal phase

A

feels like something stuck in the esophagus

137
Q

esophagus phase reasons

A

peristalsis d/o with food and water

smaller esophagus: just-food

138
Q

complications with esophageal phase

A

aspiration, malnutrition, weight loss, risk of dehydration,

139
Q

diets to help with the esophageal phase

A

consider what an individual can tolerate,

140
Q

diets for esophageal phase

A

clear liquid, full liquid, pureed, mechsoft, soft can also thicken the liquid

141
Q

IDDSI made what

A

descriptions and food classification

142
Q

Gastroesophegeal reflux disease

A

backflow of gastric contenets into esophus

143
Q

consequences of GERD

A

damage esophagus, esophagus ulcers, esophageal structure (narrowing) and can lead to dysphagia,

144
Q

barrets esophageal

A

is a cellular shift occasional heartburn, higher risk of esophageal cancer

145
Q

risk factors to GERD

A

obesity, and extra pressure on the stomach, pregnancy and hormonal changes, hiatal hernia ( above the diaphragm and pushes esophagus), meds

146
Q

managment of GERD

A

meds, diet changes, lifestyle changes, surgery if serious

147
Q

diet for GERD

A

avoid foods that relax lower esophagus sphincter

148
Q

lifestyle modification in GERD

A

loss of weight, wear loose-fitting clothes, avoid over eating, consume small meals, remain elevated b4 and after eating, quit smoking and don’t costume anything before bed,

149
Q

Peptic Ulcers

A

feels like a knowing pain and goes and comes while eating,

occurs in the upper duodenum and somatic.

150
Q

reasons for Peptic Ulcers

A

h pylori, NSAIDS (anti-inflammatory), smoking, high alcohol,

151
Q

treatment for Peptic Ulcers

A

depends on the cause, primarily with meds, antibiotics, blockage of acid production, antacids, protect the stomach lining.

152
Q

dietary intervention with peptic ulcers,

A

individual tolerance.

153
Q

when is gastric surgery necesaary

A

for stomach cancer, ulcers, or for weight loss

154
Q

what is removed in gastric surgery

A

part or whole of stomach

155
Q

what is the progression of

A

NPO, small amounts of liquid, liquid meals (no sugar), solid food 1/2 intro at a time, 5/6 small meals a day dpnd on stomach capacity.

156
Q

the complication with gastric surgery

A

dumping (early/late)

157
Q

what is dumping

A

a cluster of symptoms result from rapid emptying of osmatic load from the stomach to the small intestine,

158
Q

early dumping

A

15-30 min after food, stomach empties too fast, hypersomatic stomach – small intestine,

159
Q

symptoms of early dumping

A

nausea, vomiting, cramping, diarrhea,

160
Q

late dumping

A

1-3 hours after food, large insulin spike followed by rapid absorption of glucose, hyperglycemia.

161
Q

symptoms of late dumping

A

anxiety, dizziness, confusion, sweating, weakness.

162
Q

diet goal with dumping

A

slow down digestion, the lower osmolality of small intestine contents

163
Q

diet changes with dumping

A

small freq meals, take fluid between meals, eat protein first, avoid sweets, soluble fibers, avoid lactose

164
Q

dietary concerns with dumping

A

fat malabsorption, low amounts of vit D, and CA++, bone disease, anemia.

NEP 2380 - diet therapy (3 decks)

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